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This is the submitted version of the forthcoming article in
American Journal of Orthopsychiatry
Developmental Relationships
As the Active Ingredient:
A Unifying Working Hypothesis of “What Works”
Across Intervention Settings
Junlei Li Megan M. Julian
University of Pittsburgh Office of Child Development
Developmental relationships are characterized by reciprocal human interactions that
embody an enduring emotional attachment, progressively more complex patterns of joint
activity, and a balance of power that gradually shifts from the developed person in favor
of the developing person. We propose the working hypothesis that developmental
relationships constitute the active ingredient of effective interventions serving at-risk
children and youth across settings. In the absence of developmental relationships, other
intervention elements yield diminished or minimal returns. Scaled-up programs and
policies serving children and youth often fall short of their potential impact when their
designs or implementation drift towards manipulating other ―inactive‖ ingredients (e.g.,
incentive, accountability, curricula) instead of directly promoting developmental
relationships. Using empirical studies as case examples, we demonstrate that the presence
or absence of developmental relationships distinguishes effective and ineffective
interventions for diverse populations across developmental settings. We conclude that
developmental relationships are the foundational metric with which to judge the quality
and forecast the impact of interventions for at-risk children and youth. It is both critical
and possible to give foremost considerations to whether our program, practice, and policy
decisions promote or hinder developmental relationships amongst those who are served
and those who serve.
For citation, please use
Li, J. & Julian, M. (in press). Developmental relationship as the active ingredient: A unifying working hypothesis of ―what works‖ across intervention settings. American Journal of Orthopsychiatry.
Correspondence concerning this article should be addressed to Junlei Li, University of Pittsburgh Office of Child Development, 400 North
Lexington Avenue, Pittsburgh, PA 15208. Please send email to [email protected].
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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Traditionally rooted in medical and
pharmaceutical science, the term active ingredient
refers to the critical component of an intervention
that is responsible for producing desired change in
outcomes (e.g., sodium fluoride in toothpaste).
What if everything we do to promote children’s
positive development hinges upon a similarly
essential element? What if the efficacy of every
policy, program, or intervention is determined by
whether such effort ultimately promoted or hindered
the active mechanisms associated with such an
ingredient – the developmental ―active ingredient‖?
In this paper, we advance the working hypothesis that
there is such a universally applicable ―active
ingredient‖ underlying effective interventions. We
propose that developmental relationships –
characterized by attachment, reciprocity, progressive
complexity, and balance of power –consistently
promote positive development for children and youth
across diverse developmental settings. Furthermore,
we argue that the effectiveness of child-serving
programs, practices, and policies is determined first
and foremost by whether they strengthen or weaken
developmental relationships.
We will first define developmental relationships
with sufficient theoretical and operational specificity.
Then, using case examples drawn from empirical
studies, this working hypothesis is applied to explain
what distinguishes effective or ineffective
interventions or programs for diverse at-risk
populations. We conclude with the practical
implications of our hypothesis on program design,
professional practice, and policymaking.
Competing Hypotheses of
“Active Ingredients”
When we adopt a particular scientific theory to
address real world problems, we use the
corresponding active ingredients both as the lens to
examine the problems and as the roadmap to
formulate our solutions. For example, the various
uses of incentives and accountability to reform
educational systems or social services are rooted in
behaviorist theories (Fryer, 2010; Pawson & Tilley,
2004; Schwartz, 2001; Stecher & Kirby, 2004), and
economic theories have influenced the use of parent-
choice vouchers as an market instrument for pruning
ineffective schools. Many of our educational reform
efforts such as test-based accountability, merit pay
for teachers, pay for grades for students, and school
choice can all trace their roots to the basic theoretical
ingredients of negative reinforcement, incentive, and
market competition. However, very few policies or
programs based on these behaviorist or economic
active ingredients yield consistent or lasting positive
effects (e.g., Hanushek & Raymond, 2005; Levitt,
Janta, & Wegrich, 2008; Newmann, King, & Rigdon,
1997).
What is the alternative to the misapplication of
behaviorist or economic constructs to matters
impacting children’s learning and development?
Based on the cumulative theoretical and empirical
knowledge in developmental sciences, we propose
―developmental relationships‖ as the active
ingredient for positive and lasting developmental
change.
Developmental Relationships as the Active Ingredient
The idea that relationships are important in
human development is neither new nor controversial
to our common sense or scientific understanding.
Stated simply, relationships are the ―active
ingredients‖ of the environment’s influence
on healthy human development. They
incorporate the qualities that best promote
competence and well-being ... Relationships
engage children in the human community in
ways that help them define who they are,
what they can become, and how and why
they are important to other people. (National
Scientific Council on the Developing Child,
2004, p1)
It is evident from the cumulative scientific
knowledge that relationships are not only of central
importance to children’s early cognitive, social, and
personality development, but also have lasting
influence on long-term outcomes including social
skills, emotion regulation, conscience development,
and trust in others, and general psychological
wellbeing (see review by Thompson, 2006).
In order to formulate a testable or falsifiable
hypothesis regarding the indispensable role of
relationship in human development, we need to
operationalize ―relationship‖ beyond the common
notions of emotional attachment or connection.
Emotional connection is necessary, but insufficient to
account for the totality of how a developing person is
relating to others in her community. A working
hypothesis of relationships must also account for
interactions, activities, and power. We begin with a
classical and succinct theoretical definition of
optimal dyadic interactions (Bronfenbrenner, 1979) –
Learning and development are facilitated by
the participation of the developing person in
progressively more complex patterns of
reciprocal activity with someone with whom
that person has developed a strong and
enduring emotional attachment and when
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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the balance of power gradually shifts in
favor of the developing person. (p. 60).
The four criteria specified above – attachment,
reciprocity, progressive complexity, and balance of
power – are simple, without being simplistic. It
describes a particular style of relationship that can
apply to both dyadic and group relationships.
Therefore, whereas Bronfenbrenner coined the term
―developmental dyad‖ to denote this combination of
criteria, we now broaden it as ―developmental
relationship.‖
Interactions that befit the above definition of
developmental relationship are abundantly evident in
even the most basic and natural developmental
phenomena. Picture the familiar scene of an infant
who is learning to walk in the presence of a parent.
What enables the child to take each leap of faith is
often the outstretched arms of the parent, with whom
the infant already has an enduring emotional
attachment. The process that leads from crawling to
walking is a series of progressively more complex
developments in muscle growth, control, and
coordination (Smith & Thelen, 2003; Spencer,
Clearfield, Corbetta, Ulrich, Buchanan, & Schöner,
2006). To scaffold such development, the parent
intuitively adjusts the level of support, from holding
up the infant’s body, to just hands, to offering
emotional encouragement at a safe distance.
Throughout the learning process, the physical and
emotional interactions are joint and reciprocal. Over
time, the power or control of the walking process
shifts gradually towards the child, who advances
from being prodded and encouraged to take the first
wobbling steps or recover from a fall, to leading the
adult into a giggling game of chase.
The four criteria of the developmental
relationship – attachment, reciprocity, progressive
complexity, and balance of power – are interwoven
and interdependent aspects of one coherent
mechanism of developmental interaction, rather than
simply four separate checklist features.
The foundation of emotional attachment makes
sustained and frequent reciprocal engagement
possible without unnecessary coercions, and such
engagement in turn enhances attachment. By
attachment, we do not just mean the exclusive
connection formed between primary caregiver and
child, but any emotional connection that is natural,
positive, and appropriate for the context. Children
naturally want to sit and read with their favorite
adults. Little leaguers naturally want to go to practice
with a coach who helps them learn and makes them
feel like contributing members of the team. Even
when social systems mandate children to attend
certain types of activities, like school, there is little
doubt that attention and participation differs greatly
between a child who feel connected to a teacher and
thus eager to take part in learning activities versus a
child who passively complies.
In sustained and frequent joint activities with a
child, the adult has ample opportunity to observe and
gauge the child’s competence and confidence and
appropriately adjust the level of support to match,
otherwise referred to as scaffolding and fading
(Brown, Collins & Duguid, 1989; Collins, Brown,
Newman, 1990). A child can develop his capacities
with an adult’s support (i.e., scaffolding) and exercise
increasing control and independence with the gradual
removal of support (i.e., fading). The level and type
of adult support is thus reciprocal to the child’s
development, and the interchange between the two is
a dynamically calibrated process. Vygotsky suggests
that a child’s learning and development is best
facilitated with progressively more complex
challenges within the ―zone of proximal development‖
(ZPD), defined as:
… the distance between the actual
developmental level as determined by
independent problem solving and the level
of potential development as determined
through problem solving under adult
guidance, or in collaboration with more
capable peers (Vygotsky, 1978, p. 86).
The attentive adult, in joint and reciprocal activity,
can best locate the ZDP by matching adult control
and support to the perceived or actual difficulty
experienced by the child. Naturally, as the adult’s
support fades or as the activity advances, the child is
engaged in progressively more complex patterns of
behavior and becomes more able and willing to exert
independence and control (i.e., balance of power
shifts towards the child). Figure 1 illustrates an
idealized model of development encompassing these
interwoven processes.
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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Figure 1. An illustration of the idealized model of developmental relationship.
Like the example of infant learning to walk, such
reciprocal activities occur naturally in everyday
settings. For instance, when a child is learning to read,
an engaged and attentive parent will select a book
that matches a child’s comprehension level and offer
varying levels of support that evolve with the child’s
competence. While the parent of an novice reader
may read and act out the characters to help the child
understand and appreciate the story, the parent of a
more experienced reader might move from
storytelling to interpretation, inviting the child to take
part in the reading (e.g., ―Why does … do that?‖
―What do you think is going to happen?‖) A
proceduralized equivalent of such reciprocal patterns
of activity is ―reciprocal teaching‖ (Palincsar &
Brown, 1984), whereby children acquire increasingly
more sophisticated reading and comprehension skills
by alternately learning and teaching with their
teachers or peers.
Applying Developmental Relationships to Understand Developmental Interventions
Our working hypothesis states that human
development is best promoted when developmental
relationships are present and supported. Conversely,
human development is stifled when developmental
relationships are weakened or absent. In the
following case examples of empirical studies, we
examine this hypothesis with empirical evidence
across a broad range of developmental interventions
and settings with diverse target populations. We aim
to demonstrate that across many settings, the same
conclusion applies: when developmental
relationships are prevalent, development is promoted,
and when this type of relationship is not available or
diluted, interventions show limited effects.
Case Example 1: Orphanage Improvement Studies
Traditionally, orphanage institutions are severely
socially-emotionally depriving, so there are limited
opportunities for developmental relationships (or, any
relationships) to emerge between caregivers and
resident children. Children reared in institutions often
have stunted physical growth, aggravated behavior
problems, and prolonged attachment difficulties, and
many of these problems persist even after they are
adopted into permanent families (Chisholm, 1998;
MacLean, 2003). Using orphanages in St. Petersburg,
Russian Federation as an example, we discuss both
the characteristics of traditional orphanages, and the
implementation and effect of one particular
intervention to restructure such institutions for the
explicit purpose of enhancing caregiver-child
relationships The St. Petersburg-USA Orphanage
Research Team, 2008).
Across traditional orphanages around many parts
of the world, there are typically a host of barriers to
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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the development of caregiver-child relationships. In a
study in the Russian Federation (The St. Petersburg-
USA Orphanage Research Team, 2008), a child can
experience up to 60 to 100 different caregivers before
he reaches 19 months of age. Children are grouped
together in large same-age groups with just a handful
of caregivers, as opposed to the mixed age groups
with a proportionally larger number of caregivers that
is typical of families. Most children in these settings
eat, sleep, and play according to the same regimented
schedule, which might improve the ease of
institutional operation but limits caregivers’ ability to
devote attention to individual children. Routine care
is adult-directed and without much regard for the
children’s needs and cues. Eating, changing, bathing
are typically done ―to‖ the child mechanistically
without the smiling, talking, and eye contact that
would have been typical between a parent and a child
in a family setting. As a relic of the Soviet-era in
which conformity and order were especially valued,
even play tends to be completely caregiver-directed;
children are shown how to play with toys, and
corrected when they play with toys the ―wrong‖ way.
While there are opportunities for joint activity,
reciprocal interactions with mutually positive affect
are rare. The rigidity of adult-directed routines does
not significantly loosen even as children age. Rather,
the worsening of children’s behavioral or emotional
problems with age may further reinforce the need for
more, not less, adult control. Enduring emotional
attachments are virtually non-existent. Institutions
offer neither opportunity to engage in progressively
more complex patterns of behavior nor emotional
safety and encouragement to attempt new tasks, so
children’s competency and confidence develop
slowly, if at all. Figure 2 illustrates how development
in such a deprived setting differs from the more
idealized model in Figure 1.
A team of Russian and American practitioners
and researchers (The St. Petersburg-USA Orphanage
Research Team, 2008) designed and implemented an
intervention aimed to improve caregiver-child
relationships within institutions, with the ultimate
goal of improving children’s developmental
outcomes both within the institutions and post
adoption. Structural changes were implemented in the
institution to create family-like rooms with smaller
groups of children of mixed ages and disabilities.
Caregivers’ assignments and schedules were altered
so that one of two ―primary caregivers‖ would be
with a given group of children every day. Caregivers
were trained to respond to children in a sensitive and
reciprocal manner and to follow the child’s lead.
Further, caregivers were encouraged to take
advantage of everyday opportunities to interact
affectionately and reciprocally with children, such as
during regular care-giving activities like feeding,
dressing, bathing, and changing, much as a parent
would.
Figure 2. An illustration of development in orphanage settings deprived of typical social-emotional interactions.
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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Under the strong leadership of orphanage staff
and with the support of the international research
team, the implementation of these changes created a
context conducive to the emergence of
developmental relationships between caregivers and
children. As caregivers got to know the children
better, they became more attached to each child and
developed greater understanding of each child’s
abilities. With caregivers increasingly attending to
and following the child’s responses and leads,
caregiver-child relationships naturally progressed
into more complex and reciprocal interactions. The
emotional attachment between caregivers and
children was much stronger than before the
intervention, and in comparison with other orphanage
institutions.
Without any further changes to the children’s
nutrition or medical care, the training and structural
changes boosted the quality of relational interactions.
Both typically developing children and children with
disabilities showed substantial improvements (among
the largest ever reported from a developmental
intervention study) across all domains of
development, including physical growth (height,
weight, and head circumference), motor development,
social-emotional skills, and cognitive abilities. While
the magnitude of the improvements may be partially
due to institutionalized children’s low baseline scores,
the improvements are markedly larger and longer-
lasting than institutional interventions that do not
target relationships (e.g., Casler, 1965; Hakimi-
Manesh, Mojdehi, & Tashakkori, 1984). After the
intervention, caregivers also had lower scores on self-
report measures of their anxiety and depression,
suggesting that enhancing developmental
relationships benefits both caregivers and children.
Case Example 2: Instruction and Learning in Elementary School Classrooms
In the U.S., persisting educational challenges
have spurred continued research efforts to identify
and differentiate high and low quality instruction in
classrooms (e.g., Pianta, Belsky, Houts, & Morrison,
2007; Stigler & Hiebert, 1999). While there is
obviously no equivalence between classrooms and
orphanages, they nevertheless share some similar
institutional features. The parallel is most apparent in
low-quality classrooms. Teachers are responsible for
increasingly larger classes of same-age children, and
adult-directed instructional routines dominate the
students’ schedule and activities. Though academic
subjects become progressively more complex with
each advance in grade level, students’ participation
and engagement in low-quality instructional settings
remains limited to the passive and receptive role. In
classrooms serving economically disadvantaged
students, disciplinary practices are often needed to
maintain students’ compliance with mundane,
repetitive tasks (e.g., Haberman, 1991). Further,
teachers’ questions and feedback tend to focus more
on whether students’ answers are right or wrong
instead of the process of reaching an answer. In
focusing on outcome rather than process, teachers
may miss the opportunity to gauge a student’s deep
understanding of concepts and to support their
relationship with that student. In U.S. classrooms,
these characteristics of low quality classrooms are
typical of children’s learning experiences rather than
exceptional, especially for those who are poor (Pianta
et. al., 2007).
In these low quality classroom environments,
despite the progressive complexity of academic
subjects, the balance of power is perpetually tilted
towards the institutional requirements (e.g., curricula,
tests) and the enforcers (e.g., teachers), not the
students. Consequently, student’s competency and
development are often stifled, or at least develop in a
highly compartmentalized manner. Students may
accumulate subject knowledge without developing
critical thinking skills, intrinsic interest in learning, or
a sense of self-efficacy (Dweck, 1999). The students
who succeed initially may nevertheless continue to
expect high levels of teacher support and direction
despite their own growing competence. Those who
perpetually fail to learn may find disruptive ways to
express their frustration, making discipline and
control a continual battle that both sabotages
instruction and undermines classroom relationships
and climate (Haberman, 1991). Figure 3 illustrates
the deviation from developmental relationship
(Figure 1) under these conditions.
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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Figure 3. An illustration of development in overly-teacher-directed classroom settings.
In contrast, classrooms identified as high quality
in both domestic and international studies (Pianta et.
al., 2007; Stigler & Hiebert, 1999) embody qualities
that support developmental relationships. The
combination of instructional support and positive
climate constitute the leading predictors of
subsequent student achievement (e.g., Hamre &
Pianta, 2001). The interactions among teachers and
students in such classrooms are characterized by
sensitivity (not intrusiveness), evaluative feedback
that focuses on learning and mastery (not simply
correctness), and encouragement of child
responsibility (not over-control). For instance,
Japanese mathematics teachers in high quality
classrooms allow time and opportunity for students to
make mistakes and then engage the entire class in
diagnosing and correcting mistakes, rather than
simply correcting it for the students (Stigler &
Hiebert, 1999). Such scaffolding and fading practices
deepen students’ learning, shift students’ goals from
performance (i.e., avoid mistakes) towards learning
(i.e., use mistakes to learn), and shift the learning
process partially towards the students (i.e., students
diagnose mistakes rather than teachers offering
correction).
Under the increasing weight of curricula,
educational standards, and high stakes testing both in
the U.S. and around the world, classroom interactions
are inevitably more constrained than the idealized
model of developmental relationship. However,
effective and ineffective instructions are still
distinguishable by the degree to which the
instructional relationships between teachers and
students approximate developmental relationships.
Case Example 3: Mentoring Relationships for At-Risk Youth
The two examples above both deal with issues
within institutional settings where the goals and
needs of the institutions often take priority over the
needs of the children. This third example examines
mentoring programs in non-institutional settings
where relationship building itself, rather than
caregiving or instruction, is the primary goal.
Programs like Big Brothers Big Sisters are
designed to enhance relationships between mentors
and mentees as the foremost program objective.
Evaluations of Big Brothers Big Sisters have turned
up mixed and somewhat short-lived results in terms
of program impact on mentees (Grossman & Tierney,
1998; Herrera, Grossman, Kauh, Feldman, &
McMaken, 2007). On the surface, this seems to
contradict our hypothesis that developmental
relationship is the active ingredient for positive
development. However, even relationship-focused
programs are not the panacea for the lack of
developmental relationships. Just as orphanages and
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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classrooms can be differentiated by the quality of
relationships emerging in those settings, in the study
of mentoring relationships, Morrow and Styles
(1995) differentiated developmental relationships
from ―prescriptive‖ relationships amongst mentor-
mentee pairings.
Prescriptive relationships are found with adult
mentors who expect the mentoring relationship to
produce rapid, meaningful, lasting changes in their
mentee’s life. These mentors decided on activities
and topics of conversation without the youth’s input.
They exhibit tendencies to ―prescribe‖ activities to
the youth and such tendencies increased over the
duration of the mentoring relationship. Thus,
prescriptive mentoring relationships are characterized
by a high degree of control from the mentors that are
not responsive to the mentees’ needs and do not fade
over time. Figure 4 illustrates this dynamic.
In such a mentoring relationship, the shift in
power in favor of the mentee rarely occurs, and the
relationship quality is bound to decline over time as
the mentor remains inflexible and insistent on his or
her plans for the relationship. In fact, these
relationships show ―patterns of tension and
discontent‖ and youths are less likely to talk to their
mentors about their difficulties. Less than one third of
prescriptive mentoring relationships had long-lasting
relationships, not to mention the lack of positive
impact.
In contrast, mentors characterized as having a
―developmental relationship‖ with mentees respond
flexibly to the mentee’s needs and current level of
development. Mentees are invited to help decide
what activities are done together and whether they
want their mentor’s advice and guidance. By
including youth in the process of negotiating the
relationship, mentors are able to fade their support
over time and in response to the youth’s growing
competencies and confidence. Correspondingly, as
these relationships develop, youth often come to their
mentors to divulge problems they are having and to
seek assistance. These relationships meet consistently
and over a long period of time, and provide youth the
trusting and safe context in which further individual
development and growth are possible.
Importantly, this example demonstrates that not
any well-meaning relationship serves as the ―active
ingredient‖ in developmental interventions.
Relationships that fail to meet the criteria for
developmental relationships are neither long-lasting
nor supportive contexts for youth. In the mentoring
case, gradually shifting the balance of power towards
the youth is particularly paramount for both
engagement and impact. An authentic developmental
relationship transcends the simplistic dichotomy of
youth-driven versus adult-driven paradigms, and
strikes a balance of power through building youth
and adult partnerships (Zeldin, Camino, & Mook,
2005; Zeldin, McDaniel, Topitzes, & Lorens, 2001).
Figure 4. An illustration of development within prescriptive mentoring relationships.
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
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Case example 4: Home Visiting Programs
While the concept of developmental
relationships emerges from and is most easily applied
to the understanding of the relationship between
adults and children, it can also be extended to
understand interventions and settings that involve an
adult as the ―developing‖ person. For example, in the
context of social work and social services such as
home visiting programs, the social worker fills the
―developed‖ person role whereas the (adult) client
being served is the ―developing‖ person.
Most home visiting programs are built around
the premise that if a home visitor assists a parent, the
child will also benefit. Typical home visiting
programs begin prenatally or in the first two years of
a child’s life and focus on parent education, child
development, health care, preventing child abuse, and
parents’ well-being (Sweet & Appelbaum, 2004).
Building the relationship between the home visitor
and the parent is often part of the program focus.
There is substantial variability both within and
between home visiting programs in terms of
implementation and program impact. The evidence is
mixed as to whether home visiting has consistently
positive effects (Gomby, Culcross, & Behrman,
1999; Olds, & Kitzman, 1993; Sweet & Appelbaum,
2004; Weiss, 1993). While there is limited research
examining why some home visiting relationships
succeed while others fail, the available research is
consistent with the conceptualization of
developmental relationships as the active ingredient
in home visiting programs. Specifically, home
visiting programs that operate on a limited
instructional or case management model (e.g.,
Bickman, 1996) tend to have disappointing results,
but when there is a strong home visitor-parent
relationship and a focus on parenting strategies,
families benefit (Korfmacher, Kitzman, & Olds,
1998).
What distinguishes effective home visiting
relationships and ones with mixed or poor results?
Ideally, an effective home visitor first forms a
trusting relationship with a parent. A personal
connection between the home visitor and the parent
based on trust and acceptance may help the parent see
herself as worthy of empathy, respect, and patience
from a home visitor. The parent may in turn embody
those qualities in her own parenting. On the basis of a
personal connection, the home visitor’s support is
reciprocally matched to the parent’s emerging
competencies and needs. For a parent with few
resources and relatively low competencies, a home
visitor might actively connect the parent to resources
(e.g., food pantry, child care, social support) in the
community. As the parent becomes more competent
and resourceful, the home visitor’s support and
guidance appropriately fades into a facilitator or
mentoring role. This gradual shift in power ensures
that the parent becomes more competent in caring for
her child and in utilizing the resources available in
her community. In this way, a parent can develop
new skills (i.e., building relationships within a social
or community network) that last long after a home
visitor leaves the family.
There are circumstances where a developmental
relationship between the home visitor and the parent
is less likely to form. For instance, a home visitor
may visit infrequently, visits may be split between
multiple home visitors for one parent, or home
visitors may adhere rigidly to planned curriculum
content for visits without responding contingently to
a parent’s current competencies and needs. These
patterns of practice, often associated with
increasingly institutionalized social service systems,
echo parallel themes of inconsistent caregivers, rigid
routines, and low-quality interactions in traditional
orphanage settings. When the power consistently tilts
towards the social service institution, home visitors
are more likely to form prescriptive, rather than
developmental, relationships. The visited parents are
more likely to develop dependent, rather than self-
sufficient, tendencies. The impact of these
institutional features on home visiting includes short-
lived visitor-parent relationships and lack of impact
on parental competencies and outcomes.
Practical Implications of the “Developmental Relationship as Active Ingredient”
Hypothesis
Conceptualizing developmental relationships as
the active ingredient in human development has
important and critical implications for our efforts to
promote positive developmental change. We explore
these implications across three areas – efforts to build
programs and systems, efforts to provide aid and
assistance, and efforts to evaluate and research the
effectiveness of interventions.
“Evidence-based Programming” and “System Building” Approaches to Change
Much of what we do collectively to create
positive and lasting change in children’s development
may be categorized into two general approaches. One
approach is ―evidence-based programming‖. We
choose self-contained intervention packages with
either proven efficacy or demonstrated promise
through research and evaluation. Such interventions
range from multi-year programs that specify its target,
curriculum, and staff qualification (e.g., the 2-year
long nurse-family partnership in which nurses
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
10
provide frequent prenatal and post-birth home visits
to first-time mothers) to hour-long intervention
protocols translated from laboratory experiments
(Embry, 2004; Embry & Biglan, 2008). Treating a
well specified and self-contained program or
experimental protocol as the indivisible atomic unit
of ―evidence-based‖ intervention, the implementation
primarily focuses on how to replicate and scale up
such units with fidelity.
An extension of evidence-based programming is
the ―system building‖ approach – linking together an
amalgamation of promising interventions to
comprehensively address a wide array of systemic
factors that constrain or derail children’s
development, such as poverty, crime, education, and
parenting. For example, in early childhood work, we
integrate parent education, social services, early
intervention, and quality child care programs
(Coffman, Wright, & Bruner, 2006; Fulbright-
Anderson & Auspos, 2006; Guralnick, 2011). The
famous ―Harlem’s Children’s Zone‖ (Dobbie & Fryer,
2010) is known for taking an entire neighborhood
and transforming every aspect of the community,
including safety and sanitation, social services,
education, and parent engagement. In a cooking
metaphor, the system building approach is akin to
making a crock-pot dish whereby one hopes to stew
together ingredients which are palatable on their own
into a combination that hopefully could taste even
better.
Despite the ebb and flow of these two
complementary approaches, we as a field have not
consistently implemented reliable, sustainable, and
scalable solutions that effectively serve large
numbers of at-risk children across settings. On the
positive side, we have always had a plethora of
theoretically motivated interventions that
demonstrate promising success during pilot,
experimental, or developmental stages. To our
collective dismay, when such efforts finally earned
the privilege of being ―scaled-up‖ in large field trials
or actual use, formal evaluations often found no
effect or highly uneven effects. Such cases include
numerous after school programs (see review by
Granger, 2008), pre-school programs (e.g., U.S.
Department of Health and Human Services,
Administration for Children and Families, 2010),
home visitation programs (e.g., Wagner & Clayton,
1999), system building initiatives (e.g., Bickman,
1996), school accountability (see reviews by
Hanushek & Raymond, 2005; Newmann et al., 1997),
teacher accountability (see reviews by Levitt et al.,
2008), performance incentive for teachers or students
(e.g., Fryer, 2010; Murnane & Cohen, 1986),
mentoring programs (e.g., Grossman & Tierney,
1998; Herrera et al., 2007; Wheeler, Keller, &
DuBois, 2010), numerous literacy and mathematics
curricula, social emotional interventions, and at-risk
behavior change and prevention programs (see What
Works Clearing House listing, too numerous to
include here).
It appears that the problem of ―not working very
well for very long‖ is the norm, rather than the
exception, in existing efforts to promote
developmental change in school and community
settings. The decade-long federal program ―What
Works Clearing House‖ was designed to screen
evaluation research to identify programs that both
work and can scale. The program identified so few
programs that passed its evidence criteria that it
earned the unfortunate nickname ―Nothing Works
Clearinghouse‖ (Schoenfeld, 2006; Toppo, 2007;
Viadero, 2008).
Our working hypothesis offers a partial
explanation for the phenomenon described above and
an alternative approach to improving programs and
policies for children and youth. We believe that
programs or policies often fail in scale-up for one of
two reasons. One, the program and policy never
considered enhancing developmental relationship as
one of its main objectives. Many school curricula
experiments have mostly achievement goals and not
relational goals. Policies such as merit pay for
teachers, incentive for students’ grades,
accountability and sanctions for schools, and
vouchers for school choice do not address
relationships at all. Many of these programs and
policies not only do not enhance developmental
relationships, some adversely affect the climate and
relationship within developmental settings (e.g.,
school accountability). Second, programs that had
intended to promote relationships fail to do so with
focus and intensity in actual implementation. The
mentoring and home visiting case examples serve to
demonstrate this effect.
We believe an alternative to the evidence based
programming and system building approaches is to
focus on developmental relationship as the active
ingredient upon which the effectiveness of other
program elements depend. Viewed through the active
ingredient lens, the present system building approach
may be un-necessarily broad whereas the evidence-
based programming approach may be too narrowly
focused on experimental programs or interventions.
In program design, the focal question ought to be
―How does a (practice, program, system, or policy)
help to strengthen relationships in the developmental
setting?‖ For example, if the policy or program
decision is to adopt a new curriculum (teachers to
students, or social worker to family), the most
important question is whether or not such a
curriculum would move the relational interactions
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
11
closer to being developmental relationships, rather
than merely the content, coverage, rigor, alignment of
such a curriculum. Beyond activities, if the design
choices have to do with infrastructure (e.g., center-
based vs. home-visiting services), the question is not
just logistics or financials, but whether the
infrastructure choices enhance or inhibit the growth
of developmental relationships.
Unlike the traditional evidence-based
programming approach, we do not believe the active
ingredient is a curriculum or an intervention protocol.
Rather, it is the universal notion of developmental
relationships that can be flexibly implemented by and
integrated into a host of existing and new activities
and procedures. Likewise, in system-building efforts,
we believe that a system is not merely a coordinated
combination of different ―proven‖ interventions.
Rather, a system and all of its components ought to
provide multiple pathways deliberately constructed to
enhance developmental relationships in each
developmental setting affected by the system.
Focusing on developmental relationships does
not exclude the need for a good curriculum or a
coordinated social service system; but a well-
intentioned curriculum and social service system will
not be effective unless its implementation builds on
and enhances the quality of developmental
relationships in the classroom or the community.
Macro Level Social Change Through Aid and Assistance
While the concept of developmental
relationships originates in dyadic interactions, it may
apply to the relationship between groups and entities
that have a differential in power or expertise. While
few systematic and experimental studies have been
done on this scale, there are sufficient qualitative
accounts of change (Bradley, Curry, Ramanadhan,
Rowe, Nembhard, & Krumholz, 2009; Dickens &
Groza, 2004; Marsh, Schroeder, Dearden, Sternin,
Sternin, 2004) that allow us to extend our hypothesis
to this area for consideration. In aid and development
work, both within-country (e.g., urban community re-
vitalization) and between-country (e.g., foreign aid),
the source of the initial assistance, whether a
government entity or a non-governmental
organization, often starts as the ―developed‖ entity.
The group receiving aid and assistance starts as the
―developing‖ entity. Thus conceived, the key to
sustainable and enduring impacts and positive change
might be whether or not the two groups manage to
foster a ―developmental‖ relationship over time.
For years, foreign aid on issues ranging from
childhood malnutrition to poverty alleviation has
followed a stereotypical storyline: aid arrives,
problem lessens; aid leaves, problem returns. But
there is a counter narrative. Published first in the
British Medical Journal, an approach called ―positive
deviance‖ has gradually garnered attention (Marsh et.
al., 2004). A group of childhood malnutrition
advocates began, not pumping dollars and materials
into Vietnam villages, but first finding children and
families that defy the malnutrition norm from right
within these villages (thus named ―positive
deviance‖). This approach recognizes and
acknowledges the current capabilities of a
community rather than rigidly imposing ideas
identified by the organization providing aid. In doing
this, a positive and empowering relationship develops
between the aid-providing organization and the
receiving community, and the providers of aid serve
more as facilitators than benevolent dictators,
allowing the community to gradually take more
responsibility and control over efforts to produce
change.
In essence, by engaging the villagers themselves
to identify what worked from right under their noses,
and scaling up the change, the foreign aid workers
effectively managed to build a ―developmental
relationship‖ with the local community – earning
trust, building sophisticated local capacity for change,
and shifting the balance of power towards the people
being helped rather than building reliance on aid-
supported materials.
We believe that it is constructive to
conceptualize macro level aid and intervention
between developed and developing entities
(neighborhoods, schools, agencies, countries) as the
cultivation of a ―developmental relationship‖ akin to
that between a supportive mother and her wobbling
infant, or that between an empowering mentor and
his mentee.
Program Evaluation and Policy Research
The constructive goal of research and evaluation
is not to just prove whether a program worked by
some distal outcomes (a daunting, expensive, and
often unfruitful task), but rather to add to the
knowledge of how programs and systems need to be
implemented to maximize the impact of well known
active ingredients, and identify the program-specific
pathways that allow the active ingredients to
transform both individual and settings in an enduring
way (Pawson & Tilley, 2004). When research and
evaluation focus too narrowly on programmatic
inputs and outcomes, as typical evaluations do today,
they identify shortfalls in results without offering an
insightful understanding of why programs fail
(Hendricks, Plantz, & Pritchard, 2008; Pawson &
Tilley, 2004; Schambra, 2011). The lack of consistent,
DEVELOPMENTAL RELATIONSHIPS AS ACTIVE INGREDIENT
12
positive, and lasting outcomes only fuels more
research and evaluation for impactful programs (to no
avail) and increasing pressure on schools and
community organizations to deliver or prove such
outcomes on short order. Such pressure often
inadvertently lead schools and community
organizations further astray from promoting
development relationships through its activities and
services (Halpern, 2005).
As we believe developmental relationships
constitute the active ingredient for developmental
interventions, we argue that research and evaluation
involving developmental interventions should focus
their efforts on determining what effect the actual
implementation of programs and policies has on
developmental relationships amongst the people and
settings affected. To do that, we need credible
metrics for developmental relationships. The
empirical studies cited in our case examples offer a
range of assessment tools and methodological options
to assess developmental relationships among
caregivers and children, teachers and students,
mentors and mentees, and home visitors and parents.
In addition, we advocate for new and innovative
measures that can easily be used by non-researchers
and can quickly and reliably determine relational
quality in field settings. When quality standards and
indicators are anchored in reliable measures of
quality relationships, the research and evaluation of
programs and policies, instead of serving only as the
arbiter of competitive programs, can inform us about
how actions impact relationships so we may learn
how to better improve developmental outcomes.
To facilitate such a shift in evaluation and
research focus, government and foundation funders
of evaluation and research efforts need to adopt, at
minimum, a phased-in evaluation strategy that first
prioritizes the understanding of program or policy
impacts on developmental relationships before
proceeding to the much more expensive effort to
causally determine outcomes. As we have argued in
theory and based on empirical evidence, few
programs or policies serving children have hopes of
producing lasting outcomes if they do not enhance, or
if they undermine, the quality of developmental
relationships. The thousands of studies reviewed by
the What Works Clearing House – most of which
focused on outcomes and failed to find them – ought
to have signaled the futility of chasing after distal
outcomes without first examining credible
intermediate indicators in the present.
Conclusion
Developmental relationships are hypothesized to
be the active ingredient in developmental
interventions. Such relationships are defined
relatively parsimoniously as human interactions
characterized by four interwoven features –
attachment, reciprocity, progressive complexity, and
balance of power. We made the testable claim that
developmental interventions produce desirable
outcomes if and only if such interventions enhanced
developmental relationships, and offered case
examples of empirical studies that shed light on
developmental relationships across multiple settings
for multiple target populations.
Developmental relationships should become the
focal point for efforts intended to produce meaningful
developmental change – ―How does a (practice,
program, system, or policy) help to strengthen
relationships in the developmental setting?‖ With this
focus, decision-making starts and ends with how an
action impacts relationships.
One common response we receive when
discussing the thesis of this paper with professionals
who serve children (funders, program managers, and
researchers) is: ―We do agree with the importance of
relationship building. But funders pay for and want
hard, measurable outcomes, not soft, hard-to-measure
relationships.‖ We believe it is time to make
―developmental relationship‖ the very outcome that
is measurable and worth paying for.
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